Experiences of people from minoritised groups who report healthcare-related harm in the UK: a qualitative socioecological study exploring factors contributing to unsafe care.

OBJECTIVES: To capture the experiences of people from minoritised groups who self-report healthcare-related harm and their views on contributory factors to the harm. DESIGN: In-depth one-to-one qualitative interviews, analysed using inductive and deductive methods to explore and then organise factors participants associated with healthcare-related harm and map these factors onto a socioecological framework (SEF). SETTING: People from minoritised groups in the United Kingdom (UK) self-reporting harm arising from the National Health Service (NHS), recruited from community groups, social media and a survey of the general public. PARTICIPANTS: 48 participants currently minoritised in the UK based on one or more of faith, ethnicity, disability, sexual orientation or gender modality who have experienced harm in the NHS. RESULTS: Heterogeneous and interacting factors contribute to healthcare-related harms, spanning all five levels of the SEF: individual, interpersonal, community, organisational and societal. Multiple factors from powerlessness and low trust to unwelcoming NHS environments reinforce each other to increase risk of harm in minoritised populations. The SEF helped draw out less visible factors associated with the experience of unsafe care, including a health service designed around the needs of the majority population and societal attitudes to minoritised groups. CONCLUSIONS: Multiple individual factors are already known drivers of disparities in safety among minoritised groups such as language barriers and cultural differences in beliefs. The SEF enabled an expanded view of contributory factors to harm in these groups, thereby providing a wider set of potential interventions to address safety inequities. A narrow focus on improving the quality of interpersonal, relational care is unlikely to have a significant impact on safety improvement in minoritised groups without addressing structural and institutionalised processes that drive discrimination and exclusion.